Improvement in the Retinal Circulation after Superficial Temporal to Middle Cerebral Artery Bypass

Abstract

The retinal circulation of 35 patients (age, 30 to 71 years) with symptomatic internal carotid occlusion (22 cases) or severe inaccessible stenosis (13 cases) was studied both before and after superficial temporal to middle cerebral artery (STA-MCA) bypass surgery using ophthalmodynamometry (ODM) and intravenous fundus fluorescein angiography (IVFA). Ninety-four per cent of the patients were found preoperatively to have funduscopic findings or symptoms indicative of ocular ischemia. ODM values were abnormal preoperatively in 32 of 35 patients (91%), and improvement in ODM values for the ipsilateral eye was noted postoperatively in 25 patients (71%). ODM values obtained during the early (less than 3 months) and late (greater than 3 months) postoperative periods were significantly improved when compared to the preoperative values. IVFA values were abnormal in 25 of 29 patients (86%) preoperatively, and significant improvement was noted in 22 of 25 patients (88%) postoperatively. Preoperative patients with normal fundus examinations (10 cases) had significantly better values for IVFA and ODM than patients with venous stasis retinopathy. The findings of the study showed that STA-MCA anastomosis is beneficial in treating retinal ischemia secondary to ipsilateral severe inaccessible carotid artery stenosis or occlusion.

Superficial temporal artery to middle cerebral artery anastomosis for neovascular glaucoma due to common carotid artery occlusion

“…[ 7 10 19 20 23 25 ] However, STA-MCA anastomosis may be useful to inhibit the progression of visual disturbance by improving retinal circulation. [ 7 8 10 19 20 23 ] In fact, surgical revascularization attenuated retrograde blood flow in the ophthalmic artery and could improve the signs of neovascular glaucoma in our case, although visual acuity did not improve probably because of long-term ischemia of retina. [ 11 ] Therefore, early appropriate diagnosis and treatment would be essential to improve the visual acuity in patients with carotid occlusive diseases.…”

Effects of STA-MCA anastomosis for ischaemic oculopathy due to occlusion of the internal carotid artery

“…~6, Ausman etal. 1, Standefer et al 15, Nishikawa et al 14 and others, the importance of this disease entity as an excellent indication for bypass surgery must be highlighted especially after the negative results of bypass surgery derived by the international cooperative study were published 3.…”

Deterioration of Glaucoma After Carotid Endarterectomy

“…14,15) We present a case of internal carotid artery (ICA) stenosis complicated with neovascular glaucoma, in which glaucoma paradoxically deteriorated soon after CEA.…”